Training Coaches: Scope of Practice

A silhouette of a hand holding a lens against a blue sky, with the word "coaching" at the focal point of the lens.

We are fitness coaches.

CrossFit’s “Sickness-Wellness-Fitness” model highlights our opportunity to help humanity.

But it also shows us the limits of our practice: As a client moves to the left, from fitness to sickness, our expertise is diminished. We are not doctors. We are not physical therapists. We are not dietitians. And we don’t want to be.

Of course, we still care a lot. We desperately want to help people with Type 2 diabetes. We want to cure the lame, heal the injured, bring sight to the blind. Of course we do!

But the best way to help is to partner with true experts, not to replace them.

The Missing Piece of the Model

The real “far left” of the Sickness-Wellness-Fitness Continuum is death. But the relationship between fitness, sickness and death isn’t linear. Very fit people still die. Very fit people still get injured. And “well” people still get sick.

Greg Glassman, who created the Sickness-Wellness-Fitness continuum, said this:

“Physicians are lifeguards. Trainers are swim coaches. When you need a lifeguard, you need a lifeguard, not a swim coach. But, if you need a lifeguard, you probably needed a swim coach and didn’t get one.”

We, the swim coaches of health, applaud that message.

But that doesn’t mean lifeguards are bad.

And it really doesn’t mean we’re the lifeguards.

A Bad Image for a Good Reason

You’ve heard this one, right?

“CrossFit has been a huge gift to my surgical practice.”

It’s an urban legend, but it sums up the reason many coaches don’t trust therapists or doctors. The current medical model is full of problems: treating symptoms instead of causes, overmedicating, treating people only when they’re really sick.

I spoke to a local entrepreneur and physiotherapist about the problem on our podcast: Two-Brain Radio.

On the flip side, many doctors, therapists and health-care professionals don’t like trainers. And I really don’t blame them.

Imagine your client told you, “My tooth hurts.” You sat him or her on an incline bench, pulled out a little pocket mirror and flashlight, and found a cavity. Then you said, “I can fix this; you don’t need a dentist!” You rigged up a little drill you bought online, mixed up some MortaRx and filled the cavity.

How would you expect local dentists to react?

Why would we expect physical therapists, massage therapists or dietitians to be any different?
And are we any different when a family doctor tells our patients to eat less fat or just walk more often?

When a client gets injured, we want to take action. We don’t want to wait. We don’t want to expose the client to negative messages about exercise or diet. We don’t want the client to lapse back into the cycles that made him or her unhealthy. And we don’t want to lose the client.

Our relationship with registered health-care practitioners is fractured. No one trusts anyone else.
But we all need each other. And our clients need us to work together.

Why You Shouldn’t Do Therapy in Your Gym

A client complains:

“My shoulder hurts when I do this.”

Being people of action—exercisers! entrepreneurs!—we take matters into our own hands. We watch some videos on Instagram, light a scented candle and proceed with the Laying on of Hands.

I’ve done it a thousand times—and definitely shouldn’t have. Here’s why.

You Really Don’t Know What You’re Doing

I’m a critic of most educational institutions. I’m a skeptic of credentialing and an opponent of most licensure in health care.

But let’s face it: DPTs, massage therapists and even dietitians know something you don’t.

They’ve practiced diagnosing and treating injuries. Their education isn’t all fluff. Your duty to the client is to guide him or her to the best care. It’s hubris to think that you’ll always be the one to provide it.

You’re Not Insured to Treat Injuries

What if you misdiagnose? What if you miss something? What if you make the problem worse? Will the client miss work because of it or suffer because of it? Will he or she sue you because of it? And then what?

You Have to Protect Your Clients, Coaches and Gym From Liability

I remember watching a coach take a client of the opposite sex through a workout. At the start of the workout, the client complained of neck pain. The coach had the client roll the area with a lacrosse ball, but it didn’t help. The coach guided the client through six neck stretches, but the tightness persisted.

Then the client said, “Let me show you exactly where it hurts,” took the trainer’s hand, guided it to the right spot and said, “Yeah, right there.”

You’ve seen the end of that movie, right?

The client probably had no ill intent. The trainer certainly didn’t. But you just never know.

These are exactly the situations that cause problems down the line: complaints about unwanted touching, claims of harassment—there’s no limit to where these things can go. And when they do, people lose their reputations and their businesses.

We live in a litigious society. If you give people a reason to sue you, they eventually will.

Partnerships > Replacement

As I said earlier, I’m guilty of trying to be a therapist. I probably went way beyond my scope of practice in the early days because I was scared. I thought the regulated health-care providers would tell my clients to stop training with me.

But in reality, when I started sending clients to local therapists, I built a foundation of trust that eventually got me far more clients than I referred.

I created a referral form for my clients. When I sent them to see a physiotherapist, massage therapist or dietitian, they took the form with them. In almost every case, I got a call back from the practitioner to talk about the client. And when that happened, I always got the client back.
Here’s the kicker: No other trainers in town were doing this. So when a physiotherapist told a client, “You need to lose 30 pounds to take weight off your knee,” they didn’t trust anyone else to help them. I started getting referral forms back. That’s right: A tiny bit of trust got me a lot of referrals.

In fact, when I started taking sandwiches and coffee to local chiropractic offices, my gym membership grew faster than ever before. That’s how I met Andre Riopel (interviewed in the podcast episode above). And we’ve made hundreds of thousands of dollars off that relationship to date. I’d like to say it’s because Andre thinks I’m smart. But the reality is that he probably doesn’t trust anyone else.

Josh Martin, co-founder of Two-Brain Coaching, works with EXOS specialists when his clients need rehab. And they send athletes to him when that’s appropriate. Each partner knows the opportunities—and limits—of each practice.

The Best Solution

I could say that “the best way to make sure your clients don’t need rehab is to just stop hurting people.” But we all know that’s glib: Many new clients are on the borderline of “sickness,” and if we accept them into our care, we have to take them as they are. They might have existing problems we can’t see. Or they might be overdue for an overuse injury—or predisposed to one.

The best solution, in any case, is to build a network of trusted health-care professionals. Then prove that you are a professional by referring your clients to them, instead of trying to do their jobs.

Other Articles in This Series

Training Coaches: How to Find New Coaches
Training Coaches: Internships
Training Coaches: Continuing Education
Training Coaches: Building Careers


One more thing!

Did you know gym owners can earn $100,000 a year with no more than 150 clients? We wrote a guide showing you exactly how.